Vol. 10(9), pp. 145-150, 8 March, 2016 DOI: 10.5897/AJPP2015.4470 Article Number: 7DEE87D57152 African Journal of Pharmacy and ISSN 1996-0816 Copyright © 2016 Pharmacology Author(s) retain the copyright of this article http://www.academicjournals.org/AJPP Full Length Research Paper Did drug availability in Malawian central hospitals improve after the conversion of central medical stores to a trust? Felix Khuluza*, Precious Kadammanja, Collins Simango and Mirriam Mukhuna Pharmacy Department, College of Medicine, University of Malawi, Private Bag 360, Blantyre 3, Malawi. Received 2 November, 2015; Accepted 20 January, 2016 Malawian public hospitals have reportedly been experiencing a lot of shortages in medicines and medical supplies in recent years. This was at least in part, attributed to the traditional placement of the drug supply system under the Ministry of Health, and therefore a change in the organizational set-up was implemented in 2011. This study aimed at finding out if the availability of medicines in central hospitals in Malawi improved after the change of Central Medical Stores (CMS) to a Trust (CMST). A retrospective cohort study was done to quantify the availability of selected essential medicines before and after the change of CMS from stock cards. A questionnaire was filled by 23 health professionals to assess their views on whether the change of CMST resulted in improved availability of medicines. The study was done at Queen Elizabeth Central Hospital (QECH), Kamuzu Central Hospital (KCH) and Central Medical Store Trust. The targeted study period was before the change of CMS (2010/2011) and after (2013/2014) the change to CMST. The results of the study showed considerable reduction in stock- out days for both KCH and the CMST (from an average of 80 and 16 days to 42 and 9 days, respectively), with CMST results being statistically significant (p=0.023). However, in QECH, there was no improvement (from 22 to 24 days). The view of most respondents was that there was no improvement in medicine availability after the change of CMS, which represented a certain contradiction to the results of the quantitative part. This may be attributed to the fact that the questionnaire targeted only participants from QECH and KCH and left out participants from CMST. The study indicated that the radical shift in the management of CMS was followed by an improvement of drug availability in CMST itself, and in one of the two investigated hospitals. The non-improvement in drug availability in hospitals calls for further investigation in the future to understand the reasons for this. Key words: Central medical stores, Malawi, medicine availability, essential medicine, autonomous supply agency, pharmaceutical logistics, supply chain. INTRODUCTION The lack of access to essential medicines in developing countries is one of the most pressing global health issues *Corresponding author. E-mail: [email protected], [email protected]. Tel: +265 999289874. Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License 146 Afr. J. Pharm. Pharmacol. and had an effect on the achievement of Millennium an autonomous supply agency emerged due to the Development Goals (MDG). Also, the change of MDG to failures of the traditional CMS, and this differs from the the Sustainable Development Goals (SDG) would be traditional CMS in that the management responsibility for meaningless if lack of essential medicines in low income the CMS rests on an autonomous or semi-autonomous countries is not solved (UN Millennium Project, 2005; board (Govindaraj and Herbst, 2010; Ministry of Health Ministry of Health-Malawi, 2009). Many low-income Tanzania, 2008; Watson and McCord 2013; Wright et al, countries are still facing acute shortages of essential 2013). Until August 2011, the procurement of drugs in medicines because of the limited supply of affordable Malawi was done by CMS using the „traditional CMS medicines and inadequate logistical systems to deliver model‟ approach. However, there have been widespread them, and a continuing shortage of new products to meet documented evidence of stock-outs of drugs in public developing country‟s health needs. As such, efficient hospitals, often being attributed to the failure of the medicine logistic and supply management is viewed as traditional CMS approach (Chandani et al., 2012; Chirwa the key strategy in reducing costs of drugs and ensuring et al, 2013; Lufesi et al., 2007; Wright et al., 2013). their availability in the healthcare facilities (WHO June, Because of the failure of the traditional role, the CMS in 2004). Malawi was converted to a Central Medical Stores Trust Essential medicines are those medicines that satisfy (CMST) in 2011. This was done to reduce the the priority health care needs of the majority of the government control of CMS which was seen as being a population (Baumgarten et al., 2011; Gyimah et al., cause of inefficiencies. It was hoped that an autonomous 2009). They are selected with due regard to public health CMST would improve drug availability to the public health relevance, evidence on efficacy and safety, and system of Malawi. comparative cost-effectiveness ("WHO Model List of The organizational change from central medical stores Essential Medicines," 2013). Since 1977, the World to a trust meant that management responsibility for the Health Organization (WHO) has published a model list of CMS now began to rests on an autonomous or semi- essential medicines, and Malawi created its own autonomous board (Alternative Public Health Supply Essential Medicines List in 1987. Since then, Malawi has Chains, 2013). The system which Malawi adopted in the revised its list of essential medicines, approximately pharmaceutical supply chain is also used in other every five years. countries for example, Tanzania, Cameroon, Burkina Essential medicines are provided to the people of Faso and Senegal with mixed results (Govindaraj and Malawi free of charge at all public health facilities, and at Herbst, 2010; Gyimah et al., 2009; Tanzania, 2008). The a heavily subsidized fee in Christian affiliated hospitals. procurement system in Tanzania has improved greatly as This is due to the fact that majority of Malawians are compared to the traditional CMS that was used before poor, and the World Bank has consistently ranked Malawi the change to the semi-autonomous approach of CMS. as one of the ten poorest countries in the world in the last So far, no research has been conducted to assess the ten years (International Fund for Agricultural performance of CMST in Malawi. However, also after the Development, 2011; Index Mundi, 2015). Because of the change of CMS to a Trust (CMST), there have been extreme poverty in the country, thus 53% of the newspaper reports on frequent stock-outs of medicines in population is below poverty line (Index Mundi, 2015); it the country (Malawi News Agency, 2013a,b; 2014; becomes very difficult for majority of households to pay Masina, 2013; Mphande, 2014; Department for for the health services. Thus, the government of Malawi International Development-DfID UK,, 2011). Thus, the provided the free essential medical service to the public present study was aimed at assessing whether drug which includes free medicines. availability improved in the health facilities in Malawi after In trying to provide free medicines and medical the change of CMS to a Trust, and assessing the supplies, the Malawi government established in 1968 a perceptions of health professionals on the performance of centralized facility (Central Medical Stores-CMS) to CMST. Further, the study investigated whether the media procure medicines and medical supplies for the country‟s reports on stock-out of medicine (Malawi News Agencies public sector, for the Christian Health Association of of, August 2013, November 2013 and September 2014) Malawi (CHAM) institutions and some private non-profit were true or an exaggeration. health institutions (Supply Chain Management Assistance in Malawi, 2011; Department for International METHODOLOGY Development-DfID UK, 2011). At that time, this was the Study sites most common approach to getting medicines at a fair price for the population, and is sometimes referred to as The study was conducted at the two largest tertiary hospitals in a traditional CMS. Malawi and the Central Medical Stores Trust which supplies the The main objectives of a traditional CMS are hospitals, QECH and KCH, which are also teaching hospitals for warehousing, procurement, and distribution operations of both undergraduate and postgraduate medical and allied health pharmaceuticals which are to be done under full professional. The study population and area included CMST, QECH and KCH‟s drug stock records/cards, and health care workers from government control (as owners and executors). In contrast, QECH and KCH. Khuluza et al. 147 Study design stock were calculated from the stock cards of the selected drugs by counting the number of days when the A retrospective cohort study, for a period of 1st July 2010-30th June 2011 and 1st July 2013-30th June 2014, was used to describe drug was out of stock for the entire period. Table 1 shows whether the change of CMS to CMST was followed by an the number of days when individual drugs were out of improvement of drug availability, by looking at the stock card of stock before and after the change (Table 1). The overall selected essential medicines, and to get the perceptions of health